Psychopathology defined; Aetiology of mental illness, models explaining the causative factors

1. Psychopathology
Nirmala Roberts
India

2. Psychopathology
From ancient Greek…..
• “Psyche” from psukhē -"soul, mind, life-breath, spirit”
• “Pathos” from paskhō - "I feel, suffer” (= a condition/ state
of experiencing pain, suffering, death, misfortune, or
misery).
• “-ology ” from logia - ”the study of”
= The scientific study of a mental condition wherein the
individual suffers significant pain and misery, even to the
point that they feel as if their very "life-breath" (soul) is
being damaged or sucked out of them.

3. Psychopathology defined….
….refers to either the study of mental illness or
mental distress or the manifestation of behaviours
and experiences which may be indicative of mental
illness or psychological impairment.

4. Mental distress Vs mental illness
Mental distress Mental illness
A range of symptoms and experiences of
a person's internal life that are troubling,
confusing or out of the ordinary.
A psychological or behavioural pattern
that causes distress or disability that is
not expected as part of normal
development or culture.
Induced by life situations like stress, lack
of sleep, use of drugs or alcohol, assault
etc Mental distress when endured for longer
time  Diagnosed as ‘Mental illness’
Resolves without further medical
intervention
Not actually ‘ill’ in a medical sense.
Eg. anxiety, confused emotions,
hallucination, rage, depression etc.
A specific set of medically defined
conditions.
Eg. Schizophrenia, GAD, OCD

5. What makes a Mental Disorder
“Clinically Significant?”….
According to DSM IV –
The symptoms must be present for a specified length of time
for the diagnosis of the disorder.
The disorder –
Must reflect in a behavioral /psychological “syndrome”
Must be associated with present distress, impairment in life, or
serious risk to self or others
Must lead to adoption of an unhealthy lifestyle
Could lead to suicide, self mutilation etc
Could result in punishment/ incarceration due to his criminal acts

6. Aetiology of abnormal behavior

7. Predisposition, Precipitation &
Perpetuation
Predisposition- Inherent ability of an organism to develop the
pathogenic trait
(Eg. Heavy family h/o depression)
Precipitation – Hastening of the occurrence of the disorder at
a particular point of time
(Eg. Divorce by spouse)
Perpetuation – Continuation of the disease process
(Eg. alcohol misuse)

8. Perception
Thought Mood
Behaviour
Aetiological factors affect …..

9. Central elements that characterize
people as mentally ill…
1. Feelings - levels of psychic distress and pain (as
opposed to joy and contentment) being experienced
2. Functionality - The capacity (or lack thereof) to
coordinate the flow of resources in a desired or
adaptive way

10. Mental health and mental illness..
Mental health - when individuals
effectively coordinate resources to achieve
growth goals and feel good about it…
Mental illness - from high levels of
distress and dysfunction, with poor
‘functionality’ in managing them

11. The 4 Ds - The prominent themes that define abnormality,
within a psychological disorder.

12. Models of Mental Illness

13. Spiritual Model
The first and oldest explanatory
system for mental illness
Consciousness - deeply connected
to a supernatural force
A religious narrative of good and
bad forces in the world
Suffering – Being possessed by the bad, falling out of favor
with the good.
Sin / ‘immoral behavior’  fear and contamination.
Treatment - “Spirituotherapy”

14. Moral Character Model
Virtues like courage and stamina, honesty and integrity,
compassion and grace, enable one to live a mentally healthy life.

15. The Statistical Model
Derived more from mathematics than from psychology
‘Abnormality’ - any substantial deviation from a statistically
calculated average
Those who fall within the “Golden mean” are normal, while
those outside the mean are abnormal.

16. Transmission of genetic factors -
Monozygotic twins, first degree
relatives, polygenic
Conditions - Affective disorders,
Schizophrenia, Schizo-affective
disorders, panic disorders, phobic
anxiety disorders, OCDs and
personality disorders
The Biological Model
1. Hereditary


18. The Biological Model
2. Neurological & Biochemical
Psychopathology Seen in….
Structural
anomalies of
brain
Lighter & smaller brain; enlarged ventricles, <ed size of prefrontal
cortex & temporal lobe.
Limbic system - <ed size of hippocampus, cingulate gyrus &
amygdalae
Schizophrenia
Schizo, neurotic
disorders, GAD
Cerebral blood
flow
…in dorsolateral prefrontal cortex (Hypofrontality), cingulate
gyrus & basal ganglia.
Depression
Amygdala Activation of abnormally sensitized ‘Fear network’ by
‘panicogen's’ (CO2, Na lactate)
Panic disorders
Neuro-
pathology
Neurodevelopmental disorders – Infection, O2, malnutrition,
prolonged labour
Schizophrenia
Brain dysfunction - pregnancy, childbirth, menopause, ac/ chr
systemic diseases
Affective
disorders
Neuro-
transmitters
?Monoamines– Nor- epinephrine, dopamine, acetyl-choline -
……when <ed
…...when >ed
Depression
Mania
<ed GABA-Benzodiazepine binding,
Sertotonergic dysregulation
GAD, panic
disorders

19. Enlarged ventricles and reduction in
cortical volume

20. The Limbic System

21. The Biological/ Medical Model
2. Neurological & Biochemical
Psychopathology Seen in….
Endocrine Endocrine - Cushing’s syndrome, Addison’s disease,
hypothyroidism, hyper parathyroidism
Depression,
psychotic disorders
Drugs Drugs - INH, methyldopa, reserpine Affective disorders
Glutamate Lowered Glutamate levels
Schizophrenia
NMDA (N
methyl D
aspartate)
receptors
Hypo activity Neuro developmental defects.
Hyper activity  Neurodegenerative changes
Oestrogen &
progesteron
Delivery  Fall in oestrogen & progesterone levels 
super sensitivity of dopamine receptors
Post partum
psychosis
HPA axis Dysfunction GAD

22. The HPAAxis

23. Psychological Models
Poor adaptation to one’s environment  maladaptation
and dysfunction.
Psychodynamic Model
The Behavioural Model
The Cognitive-behavioural Model
Humanistic / Existential Model

24. Psychodynamic Model (S. Freud)
Structural theory of mind - Behaviour is motivated by subconscious
thoughts and feelings
Unresolved conflicts between the Id, ego, superego
Loss of self esteem, separation  Depressive disorders
Failure of ego defense mechanisms
Frustration & over indulgence  fixation
Treatment :
Psychoanalysis and psychodynamic therapy - Unconscious and repressed
thoughts, feelings, and conflicts believed to cause anxiety are discovered and
resolved after client gains insight

25. Topographical model of mind

26. Oral fixation….

27. Anal fixation

28. The Behavioural Model
Contiguity theory (Guthrie) - S and R connected in time and/or space will
tend to be associated
Classical/ Respondent Conditioning Theory (Pavlov) – S R (School phobia)
Operant Conditioning Theory (Skinner) – Impact of consequences on
behaviour. Faulty associative learning  Phobias
Social learning theory (Bandura) - Learning in a social context through
observation or direct instruction - OCDs, eating disorders…
Positive and negative reinforcements–
- Habituation to intrinsic fears, depression
- Behaviour inhibition in childhood
Learnt helplessness (passivity & resistance to undo -ve feelings)  Depression
Focus - On the study of directly observable behavior, the stimuli and
reinforcing conditions that control it

29. Albert Bandura’s Social Learning Theory

30. The Cognitive behavioural
Model
Distorted and dysfunctional thinking
& perception
Influence of negative life events  GAD
Meta-worry (worrying about one’s own worrying)
Misinterpretation of socially ambiguous situations
‘Catastrophic misinterpretation’ of benign bodily arousal symptoms..
From ‘learnt alarm’ Panic disorders
Treatment :
Cognitive and behaviour therapy – to learn new responses and thoughts

31. Humanistic / Existential Model
Human nature is “basically good” (Carl Rogers)
Abraham Maslow’s hierarchy of needs
Mental health problems – A signal of :
Failure to ‘grow’ and to realize one’s potentials
Focus is on –
present conscious processes and
the inherent capacity for responsible self-direction
less attention to unconscious processes and past causes
Emphasis on growth and self-actualizing rather than on curing
diseases or alleviating disorders
Does not believe in diagnostic labeling
Treatment : Humanistic therapy, logotherapy, gestalt therapy

33. Psychosocial Model…
Structure (Social structure / organization and social forces) – imposes
restrictions on behaviour (like biological inheritance)
• Lack of social relationships, insecurity, loneliness
• Threatening life events/ life changes - death, separation, parental deprivation,
unhappy marriage, unemployment, immigration, wars, natural disasters,
change of house/ work place
Process (pathological family process) – results in mental illness –
Deviant role relationship –
• Schisms - Strong split/ division
• Skewed Families – One spouse passively accedes to the strange & bizarre
concepts of the more dominant spouse
• Pseudomutual (façade of harmony) and Pseudohostile (persistent
bickering) families - due to fear of deviation from fixed expectations

34. …Psychosocial Model
Disordered communication –
• Double bind – faced with 2 or more conflicting messages
• Amorphous - Loose and incoherent
• Fragmented – incomplete and disrupted
• Expressed Emotion - Nature, quality, quantity…..
Interaction of psychological and social factors.  psychological
handicap  less resourceful in coping with social events
Basic categories of psychosocial causal factors:
Early deprivation or trauma
Inadequate parenting styles
Marital discord and divorce
Maladaptive peer relationship

35. Bio-psycho-social model
Anxiety prone – ‘Avoidant
personality disorder’ +
environmental factors

36. Diathesis-stress model
DISORDER
Treatment : Reduction of stress and learning new coping mechanisms for
times stress arises in the future

38. Positive and Negative Syndrome Scale
in Schizophrenia (PANSS)
A medical scale used for measuring symptom
severity of patients with schizophrenia –
Positive symptoms - Cognitive, emotional, and
behavioral excesses.
Negative symptoms – Cognitive, emotional, and
behavioral deficits

39. Positive Symptoms
Delusions
Hallucinations
Bizarre behavior
Formal thought disorder
Loose associations
Word salad

40. Negative Symptoms
Apathy
Avolition - Absence of motivation
Social withdrawal
Flattened/ blunted affect
Diminished verbal expression (alogia)
Poor judgment
Poor personal hygiene
Inattention
Slowed speech/ no speech
Decrease in activity level
Decrease in self direction